Archives for January 2018

I am in the middle of a cosmetic bonding nightmare. About a year ago, my dentist offered to close the gap between my two front teeth for me. I was really excited by the idea- I didn’t even know it was possible to do this without getting veneers done. They came out really nice. I like the look of them at first. However, about two weeks in, the cosmetic bonding popped off one side while I was flossing my teeth. I went back in and the dentist offered to fix it free, which I appreciated, but we didn’t talk about why it happened and I chalked it up to a fluke thing. Then, about a month later, the other one popped off while I was eating. I was mortified because I was at work and I had to go around looking ridiculous the whole day.

Fast-forward to now, I have lost one or the other a total of five times. FIVE. I asked the dentist why it kept happening and he said I was doing something to them, like flossing wrong or chewing on pencils or something. I don’t do anything like that and I’m flossing as gently as possible. Worse yet, he says if it happens again, he’s going to start charging me to fix them. I asked if he could just remove them and let me go back to normal and he said that isn’t possible.

I’m starting to wonder if maybe he shouldn’t have used cosmetic bonding in this type of application. Maybe I really should have held out for porcelain veneers. Am I right? If so, how can I fix this going forward?

Thank you,

Liza

Dear Liza,

It’s not the fact that he used cosmetic bonding in this type of application. Dentists do it all the time. It can look beautiful and last for many years. It sounds more like your dentist doesn’t know what he’s doing. Sure, it is possible to break seals, particularly if you’re doing something abnormal, like opening packages with your teeth or using your teeth as tools, but this started happening right after you had the work done. Moreover, flossing, no matter how “wrong” you do it, isn’t going to pull off the material. Not under any kind of normal circumstances. What this means is that he’s not getting a good bond on the tooth to begin with. Unfortunately, instead of realizing he’s in over his head on this one, he’s blaming you.

You can’t just take the material off and go back to normal. Some of your tooth was removed in order to shape the tooth and allow for bonding. If the material was removed, it wouldn’t look right and you’d likely get decay very quickly in those spots. Going forward, your best bet is to have the work redone by an experienced cosmetic dentist. If it does keep coming off, then you may well have some kind of subconscious habit contributing to the issue, but based on the time frame, it really sounds like an issue with the dentist, not you.

I’m curious to know if there’s a special direct composite veneers technique that’s considered minimally-invasive, or if all of them are, or if none of them are by default due to their cosmetic nature. Are there any special guidelines in their marketing and presentation?

Best,

Joel R.

Dear Joel,

Great question! Minimally-invasive dentistry is a concept that’s picking up steam with patients and practitioners alike. While most dentists already practice this way to some degree, whether or not they use the term, its accurate use helps dentists accurately market their services better and ensures patents are well-informed about their treatments and treatment options.

Minimally-Invasive Dentistry Definition

“…those techniques which respect health, function, and esthetics of oral tissue by preventing disease from occurring, or intercepting its progress with minimal tissue loss.” (Taken from Europe PMC, which attributes it to The World Congress of Minimally Invasive Dentistry.)

Ergo, in order for a procedure to be considered minimally-invasive by this standard, disease or preventing disease must be part of the reason for treatment. At a glance, that would mean that anything that’s purely cosmetic is out. However, when you consider what’s all involved in cosmetic dentistry, preventing problems and disease is an essential component. For example, we know that if the margins of a restoration are bad, the individual is likely to suffer decay there later. We know that the nerve can become irritated or even die from dental trauma. So, any kind of work, whether restorative or cosmetic, relates to this.

Minimally-Invasive Cosmetic Dentistry

The goal of minimally-invasive cosmetic dentistry threefold.

Give the patient his or her desired aesthetic outcome.

Prevent or negate disease.

Ensure “minimal tissue loss.”

Direct Composite Veneers Technique for Minimally-Invasive Dentistry

With the goal being to minimize the loss of tooth structure, chairside options already have a leg-up over traditional porcelain. It’s incredibly difficult for a dentist to get excellent cosmetic results through ultra-thin porcelain options as well. It’s doable, but only when the dentist has advanced cosmetic training. In this respect, any direct composite veneers technique could conceivably be referred to as minimally-invasive. To take it a step further, dentists would also be mindful of their preparations, keeping any reduction of the tooth to the bare minimum required to achieve the desired aesthetic result. In order to do so, many use template systems to reduce the number of layers of material they need and speed up the process.

Marketing Your Direct Composite Veneers Technique

The marketing message you’d want to send will vary based on the individual patient and his or her needs. For the conservative, health-conscious patient, calling the procedure minimally-invasive would be an accurate and fair assessment. However, you can market the same procedure as a more affordable way to improve aesthetics for your cost-concerned patients, a rapid results/ same day option for those concerned about time, and an efficient way to achieve a stunning smile makeover. Ultimately, the same procedure can be all these things and more, depending on who you’re talking to.